CMS Launches ACCESS Model to Advance Outcome-Based Payments in Medicare FFS

The Centers for Medicare & Medicaid Services (CMS) is launching the ACCESS Model, a 10-year voluntary initiative aimed at testing Outcome-based Alternative Payments (OAPs) for Medicare fee-for-service care organizations. Unlike traditional Medicare, which reimburses specific medical activities, the ACCESS Model will provide recurring payments based on measurable health outcomes related to patients' baseline health conditions. Payments and expected outcomes will vary by clinical track and patient performance, promoting a results-oriented payment structure. Participating organizations must be Medicare Part B–enrolled and designate a Medicare-enrolled Clinical Director to ensure compliance and care quality. The model excludes Durable Medical Equipment, Prosthetics, Orthotics, Supplies, and laboratory suppliers from eligibility. Medicare Advantage plans are not eligible for the model but may offer similar services. ACCESS care organizations will deploy integrated, technology-supported care that spans in-person, virtual, asynchronous, and technology-enabled methods to manage chronic conditions. Initially, the model will focus on four chronic condition tracks, though these specific tracks have not been fully detailed. This approach accommodates innovative care delivery models including telehealth and remote monitoring. CMS will accept rolling applications beginning January, with an official application deadline of March 20, 2026, and the first cohort launching on July 1, 2026. An interest form is currently available for organizations to receive application notifications. Important details regarding payment rates, risk-sharing, and quality metrics remain to be announced, and these factors are likely to influence provider participation. The ACCESS Model builds on CMS Innovation Center trends to modernize Medicare fee-for-service by embracing outcome-based payments and enabling coverage for services that support health maintenance and prevention alongside treatment. This framework allows providers to offer comprehensive, tech-enabled care beyond traditional medical services, addressing the evolving demographic demand driven by a growing population of aging baby boomers. This initiative parallels the GUIDE Model's emphasis on team-based care coordination and caregiver support, extending these principles to broader chronic conditions management. It reflects a strategic push to enhance care quality and efficiency within Medicare FFS, helping providers to compete with Medicare Advantage's more flexible offerings. Pending clarifications on payment and quality benchmarks will be crucial for stakeholders in assessing ACCESS's viability and impact. Overall, the model signals a significant shift toward value-based, integrated care in the Medicare program, supporting long-term sustainability and improved outcomes.